EX-10.18



 Exhibit 10.18 
  

							
	



	  	CONTRACT AMENDMENT	  	ARIZONA DEPARTMENT
	  	  	OF HEALTH SERVICES
	  	  	1740 W. Adams, Room 303
	  	  	Phoenix, Arizona 85007
	  	Contract No: ADHS15-085892	  	Amendment No. 2 	  	(602) 542-1040
	  	  	  	 Procurement Specialist

Ana Shoshtarikj


 PROGRAM: Behavioral Health Services Administration – Health Choice Integrated Care-HCIC 

Effective October 1, 2015, it is mutually agreed that the Contract referenced is amended as follows: 

 

	1.	Pursuant to Uniform Terms and Conditions, Paragraph 5. Contract Changes, 1. Amendments and Special Terms and Conditions, Paragraph 16. Contract Changes, Exhibit 11 Capitation Rates are hereby replaced with
the CAPITATION RATES of this amendment. 

 All other provisions shall remain in their entirety. 

 

							
	Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date.	 		 	The above referenced Contract Amendment is hereby executed this
			
		 		 	     day of             , 2015
			
		 		 	at Phoenix, Arizona
			
	     
	 		 	
	Signature	 	Date                	 		 	
	Authorized Signatory’s Name and Title:	 		 	Procurement Officer:
			
	 Mary Jo Gregory
	 		 	
	Contractor’s Name:	 		 	
			
	HEALTH CHOICE INTEGRATED CARE	 		 	


  
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	  	CONTRACT AMENDMENT	  	ARIZONA DEPARTMENT
	  	  	OF HEALTH SERVICES
	  	  	1740 W. Adams, Room 303
	  	  	Phoenix, Arizona 85007
	  	Contract No: ADHS15-085892	  	Amendment No. 2 	  	(602) 542-1040
	  	  	  	 Procurement Specialist

Ana Shoshtarikj


  

 EXHIBIT – 11 

CAPITATION RATES 

CONTRACT NO: AHDS15-085892 
  

					
	Health Choice Integrated Care	  			
	Capitation Rate for GSA 7	  			
	Effective Dates October 1, 2015 to September 30, 2016	  			
		
	 Title XIX and Title XXI eligible children, under the age of 18 (represents the cost of providing
covered behavioral health services to children), not enrolled in CMDP:
	  	$	39.14 pm/pm	  
		
	 Title XIX eligible children, under the age of 18 (represents the cost of providing covered
behavioral health services to children), enrolled in CMDP:
	  	$	1,273.31 pm/pm	  
		
	 Title XIX and Title XXI eligible adults, age 18 and older (represents the cost of providing
covered behavioral health services to adult members without serious mental illness):
	  	$	39.42 pm/pm	  
		
	 Title XIX eligible adults, age 18 and older (represents the cost of providing covered behavioral
health services to adult members with serious mental illness, who are not receiving physical health services under this contract):
	  	$	2.92 pm/pm	  
		
	 Title XIX eligible adults, age 18 and older (represents the cost of providing covered behavioral
health services to adult members with serious mental illness, who are receiving physical health services under this contract):
	  	$	1,467.89 pm/pm	  
		
	 DES DD ALTCS eligible children representing the cost of providing covered behavioral health
services to DES DD ALTCS children.
	  	$	334.85 pm/pm	  
		
	 DES DD ALTCS eligible adults representing the cost of providing covered behavioral health services
to DES DD ALTCS adults.
	  	$	147.57 pm/pm	  


  
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